Comparison of COPD patients on single inhaler and two separate inhalers for triple therapy – A short duration prospective cohort study

Abstract

Introduction: Triple therapy (Long Acting Muscarinic Antagonist (LAMA), Long Acting b 2 Agonist (LABA), Inhaled Corticosteroid (ICS)) for Chronic Obstructive Pulmonary Disease (COPD) is available as single or separate inhalers. There is a dearth of studies in real-world scenario comparing them. Materials and Methods: We followed up 33 moderate to severe COPD patients each on single inhaler (Tiotropium-Formoterol-Ciclesonide) and two separate inhalers (Tiotropium; Formoterol-Budesonide) for triple therapy for a period of three months.We compared socio-demography, Test of Adherence to Inhalers (TAI) score, baseline and improvement in FEV1, FEV1/FEV, St George Respiratory Questionnaire score (SGRQ) and Euro Qol 5 Dimension Scale score (EQ-5D) by independent t-test or Mann Whitney U test. The change in each group was compared with their baseline by paired t-test or Wilcoxon Signed Rank test. Results: The groups were comparable at the baseline with respect to age, gender, smoking, FEV1/FEV, SGRQ, EQ-5D; TAI but, separate inhaler group was worser than single inhaler group with respect to baseline FEV1 (Severe COPD - 61% Vs. 30%) and spacer use (70% Vs. 100%) (p improved significantly on FEV1, FEV1/FEV, SGRQ and EQ-5D (p separate inhalers was significantly (p 5% Vs. 1%), FEV1/FEV (median 0.04 Vs. 0.02), SGRQ (mean -50.1 Vs. -25.5) and EQ-5D (median -3 Vs. -1). Conclusion: Triple therapy improves patients by single or separate inhalers. Patients on separate inhalers had more improvement than patients on single inhaler without considering the confounding factors. Keywords: COPD, Inhalers.